The Impact of Surgical Complications on Obstetricians' and Gynecologists' Wellbeing and Coping Mechanisms as Second Victims.

BACKGROUND: Obstetric and gynecological (OBGYN) surgery is becoming increasingly complex due to an aging population with increasing rates of medical comorbidities and obesity. Complications are therefore common, and impact not only the patient but can also cause distress to the OBGYN surgeon as a "second victim". OBJECTIVE: The objective of our study was to describe and quantify the range of impacts of complications on OBGYN surgeons and assess sociodemographic, clinician and practice factors associated with such impact. STUDY DESIGN: A cross-sectional survey was developed based on interviews with OBGYNs and a review of the literature. The survey assessed OBGYN's demographic, clinical and practice characteristics, estimated number of complications per year, distress, physical and mental health, sleep, relationship impact caused by complications, and explored strategies OBGYNs used to cope with complications. Univariate logistic regression analyses were used to determine the association between OBGYNs characteristics, and complication consequences. RESULTS: Overall, of 727 survey respondents, 431 (61%) were female, 384 (55%) were 50 years or older, almost half had worked as OBGYN for 15 years or more (329 (45%)), and 527 (73%) usually complete fewer than 10 surgical procedures per week. Most (568 (78%)) reported fewer than three surgical complications per year, and most (472 (66%)) thought this was similar or less than their colleagues. Complications caused most stress when they resulted in poor patient outcomes (653 (90%)), had severe patient consequences (630 (87%)) or were a result of surgeon error (627 (86%)). Complications impacted the majority of OBGYN's wellbeing and sleep. A greater proportion of those younger than 50 years old reported that their mental wellbeing (32(10%), p=0.002) and sleep (130(42%), p=0.03) were affected when a complication occurred. Females were also more likely to report that their physical health (14(3%), p=<0.001), mental health (39(9%), p=0.01) and sleep (183(43%), p=<0.001) were affected. Current trainees (11(10%)) and surgeons with less than 15 years of experience (25(9%)) were more likely to experience mental wellbeing consequences when compared to surgeons of ≥15 years experience (12(4%))(p=0.01). Females reported less willingness to interact with colleagues when complications occurred (323(75%), p=0.006) and surgeons with less than 15 years of training were less likely to report comfort in talking (221(74%), p=0.03) and interacting with others (212(74%), p=0.02). CONCLUSION: The vast majority of OBGYN experience major impact on their health and wellbeing when one of their patients develops a complication. The degree and type of impact reported is similar to those experienced by other surgical specialties. Future studies are needed that test interventions to alleviate the significant impact and follow OBGYNs longitudinally to understand how long the impact of complications lasts.

"It's Your Own Fault": Factors Influencing Victim Blaming.

This study examined the association between victimization and victim blaming using a sample of n = 142 participants in a generalized linear mixed model (GLMM) with the influence of subject gender, victim stereotyping level, threat level, and victim gender for victim blaming. Belief in a just world was included in the model as a covariate. Mediation analyses were conducted with the degree of identifiability with the victim and attitudes toward traditional role models as explanatory approaches. In addition, acceptance of rape myths was considered. The GLMM analyses suggest that victim blaming by male subjects was significantly higher on average than by female subjects when all other predictors were held constant. As an explanatory approach for these effects of the subjects' gender on victim blaming, partial mediation was found with the degree of identification with the victim as a mediator. No main effects were found for the other influencing factors, but only a statistically significant three-way interaction. This indicates a differential effect of the level of stereotyping for male and female victims in conditions that end in high threat. The finding of the main effect of subjects' gender seems to be particularly important for the legal system, as it appears to make a difference in who is asked in terms of victim blameworthiness. This finding highlights the importance of considering a victim's personal characteristics and the need for future research with an additional focus on the characteristics of the sentencers to help clarify potential biases.

The psychological burden of major surgical complications in visceral surgery.

BACKGROUND: Complications are common after major visceral surgery. Besides the patients, also surgeons may experience negative feelings by the patients suffering. Some studies have evaluated the mental burden caused by complications, mainly focusing on residents in different surgical specialties. No evidence exists on the mental burden of board-qualified visceral surgeons in Germany. MATERIALS AND METHODS: A point prevalence study was conducted using an online questionnaire. For the inclusion of participants, all departments of visceral surgery at German university hospitals were addressed. The objective of the online questionnaire was to elaborate the perception of complications and the coping mechanisms used by the surgeons with the aim to characterize the mental burden and possible improvement strategies. RESULTS: A total of 113 questionnaires were answered, 98 being complete. 73.2% of the participants were male, 46.9% were consultants and had a working experience of 11-20 years. Most common specialties were colorectal and general surgery and 91.7% claimed to have caused complications Clavien-Dindo grade IV or V. Subsequently, predominant feelings were anger, grief, self-doubt and guilt. The fear of being blamed by colleagues or to lose reputation were high. Especially female and younger surgeons showed those fears. Coping mechanisms used to overcome those negative feelings were interaction with friends and family (60.6%) or proactive training (59.6%). Only 17.2% of the institutions offered professional support. In institutions where no support was offered, 71.6% of the surgeons asked for support. CONCLUSION: Surgical complications cause major psychological burden in surgeons in German university hospitals. Main coping mechanisms are communication with friends and families and professional education. Vulnerable subgroups, such as younger surgeons, may be at risk of suffering more from perceived mental distress. Nonetheless, the majority did not receive but asked for professional counselling. Thus, structured institutional support may ameliorate care for both surgeon and patient.

Innovative Services for Survivors of Sexual Violence: Mapping New Pathways Forward.

Ensuring that support and services are meeting the needs of survivor-victims (SV) of sexual assault requires that policymakers, service providers, and advocates seek their insight directly. This article reports qualitative results on self-perceived needs from SV focus groups conducted in the fifth-largest metropolitan area in the United States (Phoenix, Arizona). Interviews with key informants (KIs) drawn from the service and justice sector were also obtained for system-level perspectives of SV priority needs. The major themes of the SV conversations demonstrated that they use a holistic wellness perspective. Their narratives mapped across the social-ecological model and demonstrated a wide range of wants and needs beyond justice. KI narratives identified options typically listed on a grant menu. SVs spoke of what they needed in their daily lives. Typically, KIs focused on increased funds to offer more of the same interventions currently available. The findings open opportunities to better align services with what SVs seek, and further underscore the need to engage them in planning and implementation.

Post-mortem to ante-mortem facial image comparison for deceased migrant identification.

The identification of deceased migrants is a global challenge that is exacerbated by migration distance, post-mortem conditions, access to ante-mortem data for comparison, inconsistent international procedures and lack of communication between arrival and origin countries. Due to low technology requirements, fast speed analysis and ease of transferring digital data, facial image comparison is particularly beneficial in those contexts, especially in challenging scenarios when this may be the only initial ante-mortem data available to identify the deceased. The Facial Identification Scientific Working Group (FISWG) professional guidelines for facial image comparison were developed for living facial appearance, and, therefore, a tailored protocol for the application of post-mortem to ante-mortem facial image comparison was proposed and evaluated in this research. The protocol was investigated via an inter-observer and an accuracy study, using 29 forensic cases (2001-2020) from the University of Milan, provided by the Laboratory of Forensic Anthropology and Odontology. In order to replicate a migrant identification scenario, each post-mortem subject was compared to all 29 ante-mortem targets (841 comparisons). The protocol guided the practitioner through stages of facial image comparison, from broad (phase 1) to more detailed (phase 3), eventually leading to a decision of 'exclusion' or 'potential match' for each post-mortem to ante-mortem case (phase 4). In phase 4, a support scale was also utilised to indicate the level of confidence in a potential match. Each post-mortem subject could be recorded with multiple potential matches. The protocol proved to be useful guide for facial image comparison, especially for less experienced practitioners and the inter-observer study suggested good reproducibility. The majority (82-96%) of ante-mortem subjects were excluded at the first stage of the protocol, and 71 full post-mortem to ante-mortem facial image comparisons were carried out. On average, two or three potential matches were recorded for each post-mortem subject. The overall accuracy rate was 85%, with the majority (79%) of ante-mortem non-targets correctly excluded from the identification process. An increased number and quality of available ante-mortem images produced more successful matches with higher levels of support. All potential matches involving non-targets received low levels of support, and for 73% of the post-mortem subjects, the ante-mortem target was the only recorded potential match. However, two ante-mortem targets were incorrectly excluded (one at the first stage of the protocol) and therefore changes to the protocol were implemented to mitigate these errors. A full protocol and a practical recording chart for practitioner use is included with this paper.

Dealing With Complications as a Young Surgeon.

Rewarding and honorable, yet challenging and humbling, this is our chosen profession. No matter how robust of a residency and fellowship training we have had or how impactful our mentors have been, nothing can truly prepare us for dealing with complications as new attendings.

Development of the Japanese Version of the Rape Excusing Attitudes and Language Scale and Comparison Between Rape Myth Acceptance in Japan and the U.S.

Rape myth acceptance (RMA) is the acceptance of false beliefs, stereotypes, and statements about rape victims, perpetrators, and the act itself. RMA positively predicts shame felt by victims and negatively predicts reports of sexual victimization. Knowledge about sexual violence changes over time; accordingly, psychometric scales measuring RMA should be updated. Hahnel-Peeters and Goetz developed the Rape Excusing Attitudes and Language (REAL) scale by updating the Illinois RMA Scale-a major instrument used in the United States. However, the REAL scale is not available in Japanese. Therefore, we developed and validated a Japanese version of the REAL scale, evaluated RMA in Japanese individuals (N = 1,000), and compared the Japanese participants' RMA levels with the mean participant scores from Hahnel-Peeters and Goetz. In collaboration with one of the original authors, the Japanese version was developed through a back-translation process and administered to 1,000 men and women aged between 18 and 65; exploratory and confirmatory factor analyses were conducted on the data collected. The confirmatory factor analysis showed that the Japanese version moderately fitted the 4-factor structure of the original REAL scale. However, a 2-factor form obtained in the exploratory factor analysis best fit the data. Consistent with the original version, the Japanese version showed higher RMA in men than in women. The young generation (18-29 years old) self-reported higher RMA than other generations. Japan's RMA was significantly higher than that of the U.S. sample. The Japanese version of the REAL scale can be used in future studies to assess RMA in Japanese individuals and develop suitable educational programs to reduce RMA.

Who is at risk of bias? Examining dispositional differences in motivated science reception.

The motivated reception of science in line with one's preexisting convictions is a well-documented, pervasive phenomenon. In two studies (N = 743), we investigated whether this bias might be stronger in some people than others due to dispositional differences. Building on the assumptions that motivated science reception is driven by perceived threat and suspicion and higher under perceived ambiguity and uncertainty, we focused on traits associated with such perceptions. In particular, we tested the impact of conspiracy mentality and victim sensitivity on motivated science reception (as indicated by ascriptions of researchers' trustworthiness and evidence credibility). In addition, we explored the role of broader personality traits (generalized mistrust and ambiguity intolerance) in this context. None of the investigated dispositions modulated the motivated science reception effect. This demonstrates once again, that motivated science reception is a ubiquitous challenge for the effective dissemination of science and everyone seems to be at risk of it.

The Influence of Race on Detected and Undetected Sexual Offense Histories: A Comparison of White and Black Men Committed as Sexually Violent Persons.

Understanding the difference between the proportion of sexual offenses that are officially detected versus the total number of sexual crimes that occur has been of interest to decision makers for some time. Previous studies have not considered possible racial differences. More aggressive responses by police and the criminal justice system as well as cultural differences in victim type/reporting rates may result in differences between detection rates of Black versus White men. In the current study (N = 190), we examined the difference between Black (n = 51) and White (n = 139) men committed to a forensic hospital as a Sexually Violent Person on factors that could impact the detected rate. Overall, we found that White men had significantly more total victims, undetected victims, undetected and detected child victims, total male victims, undetected male victims, undetected acquaintance victims, and total (detected and undetected) acquaintance victims than Black men. Black men had significantly more detected adult victims, but this difference did not remain when accounting for undetected victims. We explore reasons for these differences as well as provide recommendations for practice.

A Realist Evaluation of a "Whole Health" Response to Domestic Violence and Abuse in the UK.

Health Pathfinder is a multilevel system change intervention initiated to transform the health response to domestic violence and abuse in eight sites in England. The current study drew upon interviews with health professionals (n = 27) and victim-survivors (n = 20) to provide a realist account of how this intervention achieved its goals. Findings show that five change mechanisms explain why Health Pathfinder was effective as an ecological intervention: awareness, expertise, relationships, empowerment, and evidence. Positive progress in respect of each mechanism had meaningful impacts on victim-survivor experiences of enquiry, disclosure, and uptake of services and had the potential to meaningfully impact health inequities.

Review of SNP assays for disaster victim identification: Cost, time, and performance information for decision-makers.

In mass disaster events, forensic DNA laboratories may be called upon to quickly pivot their operations toward identifying bodies and reuniting remains with family members. Ideally, laboratories have considered this possibility in advance and have a plan in place. Compared with traditional short tandem repeat (STR) typing, single nucleotide polymorphisms (SNPs) may be better suited to these disaster victim identification (DVI) scenarios due to their small genomic target size, resulting in an improved success rate in degraded DNA samples. As the landscape of technology has shifted toward DNA sequencing, many forensic laboratories now have benchtop instruments available for massively parallel sequencing (MPS), facilitating this operational pivot from routine forensic STR casework to DVI SNP typing. Herein, we present the commercially available SNP sequencing assays amenable to DVI, we use data simulations to explore the potential for kinship prediction from SNP panels of varying sizes, and we give an example DVI scenario as context for presenting the matrix of considerations: kinship predictive potential, cost, and throughput of current SNP assay options. This information is intended to assist laboratories in choosing a SNP system for disaster preparedness.

Confronting the inevitable: When a urologist feels like a second victim.

There are many opportunities for urologists to be emotionally impacted, and possibly injured, in the regular course of their work. In particular, urologists are vulnerable to become Second Victims as a result of errors, adverse events, and distressing clinical events. This article reviews best practices that individuals, training programs, hospitals, and healthcare systems can implement to intentionally and programmatically mitigate the short and long-term effects on healthcare professionals.

The Use of Musculoskeletal Fitness Measures as Indicators of Performance in Police Occupational Tasks.

Fitness testing is employed by some law enforcement agencies to assure performance in occupational tasks. The aim of this study was to investigate associations between musculoskeletal fitness assessment scores and performance in police occupational tasks. Retrospective data from 106 law enforcement officers who completed five musculoskeletal fitness assessments (vertical jump (VJ), hand grip strength, leg back dynamometer, 1-minute push-ups and sit-ups) and three routine occupational tasks (1.22m fence jump (FJ), 8.5m victim drag (VD) with 101kg and a get-up (GU)) were collected. A standard multiple regression was performed to determine if the results in fitness assessments were predictive of performance in the occupational tasks. Models combining all fitness assessments significantly predicted performance in FJ (F(5,88)=12.228, p<0.001; adjusted R2=0.38), VD (F(5,88)=9.407, p<0.001; adjusted R2=0.31) and GU (F(5,87)=14.319, p<0.001; adjusted R2=0.42). Further analysis of individual predictors highlighted that performance in the VJ test was a significant contributor for all models, uniquely predicting 15% of FJ (p<0.001), 4% of VD (p=0.03) and 8% of GU (p=0.001) performance. Grip strength uniquely contributed 3% to performance in the VD (p=0.05) and performance in the sit-up test contributed 8% to GU performance (p=0.001). Performance in police-specific occupational tasks requires a combination of muscular strength, power, and endurance. These musculoskeletal fitness components should be ideally assessed in recruitment and return-to work practices to ensure officers can safely and optimally perform their occupational requirements.

The Impacts of Intervention Practices With Abused Women in Domestic Violence Shelters: An Integrative Review of the Literature.

This article presents the results of an integrative review of the literature on domestic violence shelter practices, drawing upon 23 studies conducted in five countries from 25 peer-reviewed articles published between 2005 and 2020. The purpose of the review was to understand the impacts of intervention practices on abused women during their stay at a domestic violence shelter. Seven inclusion criteria were used to assess the studies included in the review. A thematic analysis revealed seven themes, divided into two main categories: formal interventions and practices related to shelter culture. These results highlight important implications for policy, research, and practices in domestic violence shelters that are discussed in this article.

Plantocratic patriarchal culture, violence against women and girls and the failures of the global health system: an interview with Marsha Hinds Myrie and Anya A. A. Lorde.

Like other parts of the world, women and girls in the Commonwealth Caribbean (CC) experience high and escalating rates of physical and sexual violence. The interview presented outlines some factors that underscore the gendered disparities of violence against women in the Caribbean as well as how healthcare responses are not developed for marginalised women and girls. The interview explores the invisibility of women and girls within healthcare and broader national healthcare structures responses through case details analysis of a Barbadian strategic litigation case. The interview calls for transdisciplinary approaches to analysing the effectiveness of the global health system that make space for not just traditional research approaches but also lived experiences 'from below' and input of advocates and activists. Despite Barbados being a signatory to a range of global health initiatives to improve healthcare responses to gender-based violence, the country does not have a formalised, comprehensive national plan to inform prevention and intervention measures. The interview shows the connections between plantocratic patriarchal culture (PPC) and the existing gaps that cause harm to women and girls who experience various types of gendered violence.

Two pictorial tools for assessing the attitudes of Taiwanese male high school students with intellectual disabilities toward sexually offensive behavior.

The purpose of this study was to develop two pictorial tools for assessing the attitudes of Taiwanese male senior high school students with intellectual disabilities toward sexually offensive behavior, focusing on cognitive distortion and victim empathy. A total of 181 male high school students at special education schools participated in this study. The validity and reliability were examined using exploratory factor analysis and Cronbach's alpha coefficient. For the cognitive distortion scale, 18 items grouped into three factors, rationalization, denial, and victim blaming, and explained 69.72% of the variance; for the victim empathy scale, 12 items grouped into two factors, the victim's feelings when the offensive behavior is perpetrated by another, and the victim's feelings when the offensive behavior is perpetrated by oneself, and explained 68.00% of the variance. The reliability was .96 for the cognitive distortion scale and .93 for the victim empathy scale. In conclusion, the two scales developed in this research were found to be reliable and valid tools for evaluating male students' attitudes toward sexually offensive behavior, and can also be used as reference material for courses in sex education.

Facial recognition for disaster victim identification.

Mass disaster events can result in high levels of casualties that need to be identified. Whilst disaster victim identification (DVI) relies on primary identifiers of DNA, fingerprints, and dental, these require ante-mortem data that may not exist or be easily obtainable. Facial recognition technology may be able to assist. Automated facial recognition has advanced considerably and access to ante-mortem facial images are readily available. Facial recognition could therefore be used to expedite the DVI process by narrowing down leads before primary identifiers are made available. This research explores the feasibility of using automated facial recognition technology to support DVI. We evaluated the performance of a commercial-off-the-self facial recognition algorithm on post-mortem images (representing images taken after a mass disaster) against ante-mortem images (representing a database that may exist within agencies who hold face databases for identity documents (such as passports or driver's licenses). We explored facial recognition performance for different operational scenarios, with different levels of face image quality, and by cause of death. Our research is the largest facial recognition evaluation of post-mortem and ante-mortem images to date. We demonstrated that facial recognition technology would be valuable for DVI and that the performance varies by image quality and cause of death. We provide recommendations for future research.

"Snapping, sharing and receiving blame": A systematic review on psychosocial factors of victim blaming in non-consensual pornography.

Non-consensual pornography has become a growing concern, with potentially negative consequences for the victims. Victims of revenge porn are more likely to be blamed, and understanding why and how blame is attributed toward victims of non-consensual pornography is crucial to support them and reduce the negative consequences. This study aimed to explore and synthesize the existing evidence on victim blaming in non-consensual pornography and the underlying psychosocial factors within the context of attribution framework. A comprehensive systematic review was conducted across four databases namely PubMed, ProQuest, Google Scholar, and Scopus for English-language studies published from April 2012 to June 2022. Data from the selected studies were extracted and collated into the review matrix. Among the 22 full-text reviews, 10 records that met the eligibility criteria were included in the final review. Two themes namely "Culture and morality" and "gendered differences in attributions of blame" were derived from a thematic synthesis of 10 studies and reflected the psychosocial underpinnings of victim blaming. The review highlighted how cultural narratives and perceived immorality play a major role in how attributions are placed on self or others for victim blaming in "non-consensual pornography." Blame attributions emerging from gender stereotyping and gendered responsibilization within cultural and societal contexts were found to impact self-blame and compound victimization in non-consensual pornography. The study findings implicated that recognizing psychosocial underpinnings of victim blame attribution in revenge porn would allow for evolving suitable legislative and policy responses for designing effective educative and preventative strategies.

A review of the contributions of forensic archaeology and anthropology to the process of disaster victim identification.

Forensic archaeology and anthropology have developed significantly over past decades and now provide considerable assistance to the investigation process of disaster victim recovery and identification. In what are often chaotic death and crime scenes, the formal process of utilizing archaeological methods can bring control, order, and ensure systematic search. Procedures assist in defining scene extent, locating victims and evidence, rule out areas for consideration, and provide standardized recording and quality assurance through dedicated use of standardized forms (pro formas). Combined archaeological and anthropological search methods maximize opportunities to recovery the missing through identifying remains, mapping distributions, and providing accounting of victims at the scene. Anthropological assistance in examinations contributes to individual assessment, resolving commingling and fragmentation issues, and utilizing DNA sampling methods and matching data to reassociate and account for the missing. Utilization of archaeology, anthropology, and DNA matching data provides scope to review crime scene recovery and determine requirements and potential for further survey and retrieval. Adopting the most suitable methods for a particular context can maximize recovery, efficiency, and resource use. Case studies demonstrate the utility of archaeological methods in a range of scenarios. They exemplify the success of multidisciplinary analysis in providing evidence of the sequence of events, the timing of events, the impact of taphonomic processes, the location and accounting of victims, and the demonstration of systematic scene search. The considerations provided in this article, utilizing archaeology and anthropology processes, may assist investigators in planning and implementing responses to mass fatalities.

Impact of second victim distress on healthcare professionals' intent to leave, absenteeism and resilience: A mediation model of organizational support.

AIMS: To examine the relationship between the second victim distress and outcome variables, specifically: 'turnover intentions, absenteeism and resilience'. Furthermore, this study also assessed how organizational support mediates the relationship between second victim distress and outcome variables. DESIGN: Cross-sectional survey. METHODS: A cross-sectional survey study using regression and mediation analysis with bootstrapping was conducted among (n = 149) healthcare professionals in two university hospitals in Finland from September 2022 to April 2023 during different time periods. The Finnish version of the revised Second Victim Experience and Support Tool (FI-SVEST-R) was used to assess second victim distress, level of organizational support and related outcomes. RESULTS: Psychological distress was the most frequently experienced form of reported second victim distress, and institutional support was the lowest perceived form of support by healthcare professionals. The study found second victim distress to have a significant association with work-related outcomes: turnover intention and absenteeism. However, no significant relationship was found with resilience. Mediation models with organizational support revealed a partially mediated relationship between second victim distress and work-related outcomes. CONCLUSIONS: The findings from this study indicate that second victim experiences if not adequately addressed can lead to negative work-related outcomes such as increased job turnover and absenteeism. Such outcomes not only affect healthcare professionals but can also have a cascading effect on the quality of care. However, the mediating effect of organizational support suggests that if comprehensive support is provided, it is possible to mitigate the negative impact of the second victim phenomenon. IMPACT: Raising awareness regarding the second victim phenomenon, promoting a culture of safety and shifting the paradigm from a blame to just culture helps in identifying the system flaws thus improving both patient and provider safety. REPORTING METHOD: The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.